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I did a home visit with a client I have seen previously for initiation of breastfeeding. Baby has what the ENT calls a "borderline" posterior tongue restriction, but is gaining weight well and mom's nipples have healed and the dyad is breastfeeding very well, despite "small" latches as reported by mother. 
Mom is due to return to work in October, and after 7 weeks and establishment of good breastfeeding, the midwife suggested introduction of bottles. Family complied, but baby refused. For the past 3 weeks, family has been working toward this goal, as baby is now 10-11 weeks. 

We have tried paced bottle feeding baby while skin to skin with the father, mother left the house, tried introducing a straw with some limited success, tried feeding baby whilst she was upright propped on dad's knees, making sure to use bottle to stimulate baby's high-arched palate. 

The family has tried quite an array of different bottles and now sippy cups. For all of these, baby's tongue appears entirely nonfunctional, despite quite efficient breastfeeding. She'll open her mouth, stick out her tongue, and sort of gum the bottle or straw, suck halfheartedly, and that's about it, regardless of persistence and how hungry she seemed to be. The cup was met with limited success, and father was less than enthusiastic about this option.  

I suggested trying 3x/week and giving her breaks in between, attempting morning sessions instead of evening, perhaps trying in the bath or outside, switching up her environment, cup feeding, and allowing the possibility of total bottle refusal and applying some creative thinking to mom's work schedule. 

She's pretty worried about baby "reverse cycling," as she's afraid of the impact that disrupted sleep will have on the whole family. I counseled safe co-sleeping strategies if that were to be the case, and suggested a mother's helper as mom works at home. Mom wasn't interested in this arrangement. 

Something I'm missing, here? I was there for about two hours trying to help find a solution. I'd love to offer this family more support! Thanks in advance!

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